Adequacy of Children's Psychopharmacology Services: Variations by Race and Clinical Characteristics.
Adequacy of Children's Psychopharmacology Services: Variations by Race and Clinical Characteristics.
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儿童精神药理学服务的充分性：因种族和临床特征而异。
DOI：
10.1176/appi.ps.20220375
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Horwitz,SarahM
中科院分区：
文献类型：
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作者：
Young,AndreaS;Findling,RobertL;Riehm,KiraE;Seegan,Paige;Crum,RosaM;Mojtabai,Ramin;Chiappini,ErikaA;Youngstrom,EricA;Fristad,MaryA;Arnold,LEugene;Birmaher,Boris;Horwitz,SarahM
目的采用专家共识方法来确定儿童精神药理学的充分性，并检查充分性是否因人口或临床特征而异。方法数据来自对 601 名 6-12 岁儿童的基线访谈，这些儿童曾访问过 9 个门诊心理健康诊所之一，并参加了躁狂症状纵向评估研究。儿童和家长接受了《儿童情感障碍和精神分裂症时间表》以及《儿童和青少年服务评估》的采访，以分别评估儿童的精神症状和终生心理健康服务的使用情况。采用已发表的治疗指南中的专家共识方法来确定儿童精神药物治疗的充分性。 结果黑人儿童（与白人儿童相比；OR=1.84，95% CI=1.53–2.23）和患有焦虑症的儿童（与无焦虑症患者相比；OR=1.55，95% CI=1.08–2.20）更有可能接受不充分的药物治疗；那些照顾者拥有学士学位或以上教育程度的人（与那些拥有高中教育、普通同等文凭或低于高中教育的人相比；OR=0.74，95% CI=0.61-0.89）接受不充分药物治疗的可能性较小。 结论 共识评估者方法允许使用已发表的治疗效果数据和患者特征（例如年龄、诊断、近期住院史和心理治疗）来评估充分性的药物治疗。这些结果重复了先前研究中报告的种族差异的结果，使用传统方法来确定治疗充分性（例如，以最少的治疗次数），并强调需要继续研究种族差异和改善获得高质量护理机会的策略。
ObjectiveAn expert consensus approach was used to determine the adequacy of children’s psychopharmacology and to examine whether adequacy varied by demographic or clinical characteristics.MethodsData were from the baseline interview of 601 children, ages 6–12 years, who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. Children and parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child’s psychiatric symptoms and lifetime mental health services use, respectively. An expert consensus approach informed by published treatment guidelines was used to determine the adequacy of children’s psychotropic medication treatment.ResultsBlack children (compared with White children; OR=1.84, 95% CI=1.53–2.23) and those with anxiety disorders (vs. no anxiety disorder; OR=1.55, 95% CI=1.08–2.20) were more likely to receive inadequate pharmacotherapy; those whose caregivers had a bachelor’s degree or more education (vs. those who had a high school education, general equivalency diploma, or less than high school education; OR=0.74, 95% CI=0.61–0.89) were less likely to receive inadequate pharmacotherapy.ConclusionsThe consensus rater approach permitted use of published treatment efficacy data and patient characteristics (e.g., age, diagnoses, history of recent hospitalizations, and psychotherapy) to assess adequacy of pharmacotherapy. These results replicate findings of racial disparities reported in previous research using traditional methods to determine treatment adequacy (e.g., with a minimum number of treatment sessions) and highlight the continued need for research on racial disparities and strategies to improve access to high-quality care.